We propose to continue the New England Regional Coordinating Center (NERCC), an integrated team of hospitals and EMS agencies in Boston and Western Massachusetts that will serve as a top-enrolling site and vibrant contributor to the NINDS Stroke Trials Network. Our group includes many of the major adult academic stroke centers in the Greater Boston area, and our 30+ hospital New England TeleStroke referral network will extend our potential recruitment even further. All core hospitals have a proven track record of successful management and performance of clinical trials. In particular, all hospitals have an established research infrastructure that performs ongoing clinical research in stroke neurology with strong collaborations across disciplines. Principal investigator Lee H. Schwamm, MD, and Co-Investigators bring a complementary set of skills in managing successful translational clinical research programs, membership on Steering Committees, and positions of national leadership in their fields. Our team includes seasoned clinical investigators in vascular neurology, emergency medicine, neuroendovascular, neurosurgery, neurointensive care, neuroimaging, stroke rehabilitation, and preclinical basic and translational stroke investigation in both adults and children. Strengths of the NERCC team include 1) close personal and professional ties between multiple investigators; 2) large patient population from diverse hospital settings in a major metropolitan area; 3) talented teams of site investigators with track records of scientific achievement, innovation, and subject recruitment in multicenter trials; 4) robust existing NINDS-funded research and clinical trial management infrastructure; 5) existing clinical research programs, e.g., Neurology Clinical Research Institute, NIH Clinical and Translational Science Award programs at Boston University and across Harvard; Sites in the SIREN and NeuroNEXT Clinical Coordinating Center. Overall, the NERCC Team has demonstrated outstanding commitment and performance in the first StrokeNet cycle, and has the resources, vision, and enthusiasm to continue to develop new translational science and successfully execute the NINDS StrokeNet Phase 1,2 and 3 trials.